Transthoracic Approach for Pott's Disease

Richardson, J. David; Campbell, Donald L.; Grover, Frederick L.; Arom, Kit V.; Wilkins, Kaye E.; Wissinger, John P.; Trinkle, J. Kent

doi:10.1016/s0003-4975(10)63928-8

Cited by 22 publications

(10 citation statements)

References 12 publications

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“…14 Except in endemic pockets, Pott's disease is now a rare indication for spine surgery in the developed world. 15 Instrumentation inventions have led to better operations for expanded indications. Posterior stabilization by Harrington rods 16 and anterior stabilization devices developed by Dwyer et al 17 were noteworthy innovations.…”

Section: Historymentioning

confidence: 99%

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Methods and Complications of Anterior Exposure of the Thoracic and Lumbar Spine

Ikard¹

2006

Arch Surg

135

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To review the methods and complications of exposing the anterior aspects of the thoracic and lumbosacral spine. Data Sources: PubMed (journals database of the National Library of Medicine), text books, the University HealthSystem Consortium Clinical Process Improvement Benchmarking Project, a newspaper, and the US government Healthcare Cost and Utilization Project. Study Selection: Descriptions of morbidity and mortality specifically related to anterior spine exposure depicted in both case reports and clinical series were used. Data Extraction: Mortality data from clinical series with more than 30 cases were tabulated. Morbidity incidences were described. Data Synthesis: The frequency of anterior exposure of the spine for structural operations is steadily increasing. Both thoracic and lumbosacral anterior spine operations are associated with exposure-related complication rates of 10% to 50%. Pulmonary complications are frequent after thoracic exposures. Chylothorax is the most common of several rarer chest-exposure complications. Vascular complications, particularly arterial thrombosis (Ͻ1% of cases) and venous bleeding (2%-15% of cases), are the most frequent complications at the lumbar level. Other lumbosacral exposure complications include ureteral and nerve (somatic and sympathetic) injury. The mortality rate in anterior spine exposures is less than 1%. Conclusions: The exposure portions of anterior spine operations result in numerous complications. There are fewer reported complications with endoscopic exposures of the anterior spine than with open exposures, although endoscopic exposures have been used for less complicated cases. In comparable cases, neither exposure nor results of endoscopic operations have proven better than operations done through minilaparotomy incisions. Perioperative cooperation between exposing and spine surgeons is necessary to enhance results in anterior spine operations.

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Section: Historymentioning

confidence: 99%

“…[24][25][26] Because of ribs' lateral, caudad curvatures, most surgeons remove ribs 1 to 2 interspaces above the affected spine. 8,15,20 The upper spine, T2 through T6, is approached more easily from the right side (Figure 1). Distal to that, the left side is preferred.…”

Section: Thoracic Openmentioning

confidence: 99%

Methods and Complications of Anterior Exposure of the Thoracic and Lumbar Spine

Ikard¹

2006

Arch Surg

135

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“…[7] However, with the advent of antitubercular therapy, a decline in the number of cases was seen. [1] We suggest that the majority of asymptomatic patients can be managed with antituberculous therapy and bed rest but certain cases in which patients develop neurologic deficits and have radiologically significant cord compression have to be decompressed surgically.…”

Section: Discussionmentioning

confidence: 99%

Transthoracic approach for lesions involving the anterior dorsal spine: A multidisciplinary approach with good outcomes

Balasubramaniam

Tyagi

Zafar

et al. 2016

J Craniovert Jun Spine

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Introduction:Anterior approach provides excellent visualization and access to the anterior thoracic spine. It may be used alone, in combination with a posterior midline approach or in a staged or sequential fashion.Aims:To analyse our institutional experience in transthoracic approaches and to determine the safety and benefit of this approach in our patient series.Materials and Methods:A total of 16 patients were operated for varying lesions of body of dorsal vertebra by the transthoracic approach. The study was for a period of 5 years from January 2011 to December 2015. Patients age ranged from 25 to 61 years with an average of 36.4 yrs. There were 7 males and 9 females. In our series 9 patients had Kochs spine, 4 patients were traumatic fracture spine and 3 had neoplastic lesion. Majority of patients had multiple symptoms with backache being present in all patients.Results:There was one post operative mortality which was unrelated to surgery. One patient had post operative delayed kyphosis. Remaining patients improved in their symptoms following surgery.Conclusion:With careful coordination by thoracic surgeons, neurospinal surgeons and anaesthetists, the anterior spine approach for dorsal spine is safe and effective. Adequate preoperative evaluation should stratify the risk and institute measures to reduce it. Accurate surgical planning and careful surgical technique are the key to yield a good outcome and to reduce the risk of complications.

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“…As vértebras torácicas inferiores e lombares são as mais frequentemente afetadas, seja por contigüidade pleural ou por disseminação hematogênica. A lesão inicial é na porção anterior do corpo vertebral acarretando a destruição deste e o aparecimento da cifose (giba), característica do mal de Pott 2,3,5 .O tratamento ideal para TB espinhal quando existe déficit neurológico, resistência bacteriana, imunossupressão, instabilidade ou deformidade importante é a ressecção cirúrgica radical da lesão, com instalação de enxerto e drenagem do abscesso paravertebral, se presente 4,[6][7][8] . A instrumentação é necessá-ria nos casos de instabilidade da coluna 4,8,9 .…”

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“…O tratamento ideal para TB espinhal quando existe déficit neurológico, resistência bacteriana, imunossupressão, instabilidade ou deformidade importante é a ressecção cirúrgica radical da lesão, com instalação de enxerto e drenagem do abscesso paravertebral, se presente 4,[6][7][8] . A instrumentação é necessá-ria nos casos de instabilidade da coluna 4,8,9 .…”

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Instrumentação anterior da coluna em espondilite tuberculosa mal de pott: Relato de caso

Farage¹,

Martins

Filho³

2002

Arq. Neuro-Psiquiatr.

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RESUMO -Relatamos caso de tratamento cirúrgico com instrumentação anterior em espondilite tuberculosa (mal de Pott), em mulher de 71 anos, que se encontrava em tratamento para tuberculose na forma pulmonar e evoluiu com dor lombar, dificuldade progressiva para deambular, cifose e disfunção vesical. A ressonância magnética revelou lesão nos corpos vertebrais de T12 e L1 com abcesso paravertebral. A paciente foi tratada cirurgicamente por acesso tóraco-abdominal lateral. Os corpos vertebrais foram ressecados, foi instalado uma gaiola vertical (mesh cage) e a coluna foi estabilizada com placa lateral (Z plate) e parafusos fixados em T11 e L2. Essa técnica permite boa artrodese dos corpos vertebrais remanescentes e boa estabilidade da coluna, sem comprometer a eficácia dos tuberculostáticos. A paciente foi avaliada um ano após a operação e não apresentava déficit motor, dor residual e a cifose foi desfeita.PALAVRAS-CHAVE: mal de Pott, tratamento cirúrgico, instrumentação anterior.Anterior instrumentation in tuberculous spondylitis (P Anterior instrumentation in tuberculous spondylitis (P Anterior instrumentation in tuberculous spondylitis (P Anterior instrumentation in tuberculous spondylitis (P Anterior instrumentation in tuberculous spondylitis (Pott's disease): case report ott's disease): case report ott's disease): case report ott's disease): case report ott's disease): case report ABSTRACT -We report a case of a surgical treatment with anterior instrumentation in tuberculous spondylitis (Pott's disease), in a 71 years old woman, that was in treatment for pulmonary tuberculosis, with lumbar pain, progressive disability to walk, kyphotic deformit and vesical dysfunction. Magnetic resonance image presents a lesion in the bodies of T12 and L1, with paravertebral abscess. The patient was treated surgically by transthoracic-abdominal approach. The vertebral bodies were cut off and the spine were instrumented anteriorly with a mesh cage and a Z plate. This procedure permits a good arthrodesis and a immediately stabilization of the spine, without any complication of the infection. The patient was seen a year after the surgery and is free of infection, without motor deficit, pain or reminiscent kyphosis.KEY WORDS: Pott's disease, surgical treatment, anterior instrumentation. 1 . Dentre os vários locais atingidos pela doença, o pulmão é o mais frequente e a afecção óssea representa a quinta mais comum nas formas extrapulmonares 2 . Dentre estes casos 50% apresentam doença na coluna vertebral [2][3][4] . A concomitância pulmonar e vertebral ocorre em 10-15% dos pacientes 2,3,5 . As vértebras torácicas inferiores e lombares são as mais frequentemente afetadas, seja por contigüidade pleural ou por disseminação hematogênica. A lesão inicial é na porção anterior do corpo vertebral acarretando a destruição deste e o aparecimento da cifose (giba), característica do mal de Pott 2,3,5 .O tratamento ideal para TB espinhal quando existe déficit neurológico, resistência bacteriana, imunossupressão, instabilidade ou deformidade impor...

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Transthoracic Approach for Pott's Disease

Cited by 22 publications

References 12 publications

Methods and Complications of Anterior Exposure of the Thoracic and Lumbar Spine

Methods and Complications of Anterior Exposure of the Thoracic and Lumbar Spine

Transthoracic approach for lesions involving the anterior dorsal spine: A multidisciplinary approach with good outcomes

Instrumentação anterior da coluna em espondilite tuberculosa mal de pott: Relato de caso

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